| Organization Name: | RIVER OF LIFE REHAB, LLC |
| NPI Number: | 1457523474 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANNA SORENSEN (OWNER) |
| Mailing Address: | 44 Scotts Blf Grand Marais |
| State: | MN US |
| Postal Code: | 556042197 |
| Phone Number: | 2183879185 |
| Fax Number: | |
| NPI Enumeration Date: | 03/31/2008 |
| NPI Last Update Date: | 03/31/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | 101611 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |